This paper was commissioned by UNRISD, in collaboration with UNAIDS, to provide background for new comparative research on HIV/AIDS as a problem of development. Moving away from an epidemiological or behavioural focus on the pandemic, the essay begins by considering AIDS in the context of widespread and worsening poverty. Two strategies adopted by desperate people, attempting to improve their income, are particularly conducive to the spread of HIV/AIDS. The first is migration in search of work, whether within countries or across borders. The second is poverty-driven commercial sex work. Both place men and women in particularly high-risk situations, in which institutions providing normal support for stable family relations are absent.

The third section of the paper provides examples of vigorous community responses to the pandemic, and the fourth looks critically at three interrelated approaches on the part of public health and donor agencies attempting to expand and improve their efforts: integration of HIV/AIDS prevention and care with existing sectoral programmes; mainstreaming of prevention and care into normal bureaucratic activities (including planning, budgeting and evaluation); and scaling up effective initiatives to cover a wider area or a larger number of people.

The paper ends with suggestions for further social science research on HIV/AIDS and development.